Impact of emotional distress and pain-related fear on patients with chronic pain: Subgroup analysis of patients referred to multimodal rehabilitation
Mikael Svanberg, Britt-Marie Stålnacke, Paul Enthoven, Gunilla Brodda-Jansen, Björn Gerdle, Katja Boersma
Psychosomatic Medicine Clinic, Karlsgatan 17 A, SE-722 14 Västerås, Sweden
Objective: Multimodal rehabilitation programmes (MMRP) for chronic pain could be improved by determining which patients do not benefit fully. General distress and pain-related fear may explain variations in the treatment effects of MMRP.
Design: Cohort study with a cross-sectional, prospective part.
Patients: Chronic musculoskeletal pain patients referred to 2 hospital-based pain rehabilitation clinics.
Methods: The cross-sectional part of this study cluster analyses patients (n = 1,218) with regard to distress and pain-related fear at first consultation in clinical pain rehabilitation and describes differences in external variables between clusters. The prospective part follows the subsample of patients (n = 260) participating in MMRP and describes outcome post-treatment.
Results: Four distinct subgroups were found: (i) those with low levels of distress and pain-related fear; (ii) those with high levels of pain-related fear; (iii) those with high levels of distress; and (iv) those with high levels of distress and pain-related fear. These subgroups showed differences in demogra-phics, pain characteristics, quality of life, and acceptance, as well as the degree of MMRP participation and MMRP outcome.
Conclusion: Among patients with chronic pain referred to MMRP there are subgroups with different profiles of distress and pain-related fear, which are relevant to understanding the adaptation to pain and MMRP outcome. This knowledge may help us to select patients and tailor treatment for better results.
Distress and pain-related fear bear meaning for understanding chronic pain patients’ adaptation to pain and outcome in rehabilitation
There is a connection between worrying, distress and chronic pain. A group of pain patients referred to rehabilitation were analyzed and we could conclude that there were subgroups with different levels of distress and pain-related fear among them. Compared to the other patients, the patients with highest distress and pain-related fear found it harder to accept pain, had lower quality of life and were less likely to go into rehabilitation. While those who did continue to rehabilitation improved, they still had significant remaining problems after rehabilitation. This study shows the need for focusing on psychological factors when assessing and treating chronic pain.
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